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The NHS RightCare Hot Housing Implementation Lead for the North region reflects on what is changing so that future innovations can be adopted sooner.
Of the many different roles that I encountered when I started my nurse training in 1992, the best fit for me were those of a more technical nature.
On qualifying in 1995, I was delighted to be offered a job as an Intensive Care Unit Staff Nurse. This is where I learned to care for patients, and their families, at a very vulnerable time.
It’s where I came to understand and appreciate the vast array of technologies used as an integral part of that care.
Simple, yet highly complex, technologies, such as haemofiltration, can have an immeasurably positive impact upon a patient’s life. While life-changing technologies like this are in widespread use across the NHS, other technologies, which are arguably of similar benefit, can face slow adoption or barriers to their widespread uptake.
So what is it that prevents some technologies which are evidence based, good for patients and cost effective, from being used?
It could be suggested that if something is truly innovative then widespread uptake and spread will occur organically. However, there have been numerous reports and papers that have indicated this is not the case. The King’s Fund and Nuffield Trust have both published papers which look at the specific issue of innovation within the NHS and some of the barriers faced.
There are, of course, many issues which can positively or negatively influence the likelihood of an innovative device or process being scaled up and used more widely. From my own experience, having worked both with med-tech companies and as a frontline clinician and manager, I would suggest that the barriers to adoption – and the solutions – can be complex.
Some of the common reasons for delayed, or poor, adoption include issues such as:
- A supply driven approach to innovation within the NHS. This can mean that innovations are developed and driven by industry rather than frontline clinicians, or, more importantly, in collaboration with patients.
- The need to develop a robust evidence base for new innovations. Whilst important, this can delay timely implementation.
- Looking for innovative practice and undertaking the hard work of sustainable implementation is not often considered to be part of anybody’s day job.
- Innovations may only be seen as successful if they can produce immediate positive effects, such as in-year savings, at the location of implementation. Those innovations which have wider pathway benefits, over a longer timeframe, can struggle to be adopted.
This list is by no means exhaustive but does give a flavour of the sort of hurdles to be navigated. There are also invariably practical and local issues which need to be worked though during the implementation of any innovation.
So, what is changing and how do we overcome these barriers? As mentioned, there are lots of innovations and best practice that are making a real difference, but this can be within silos. The challenge then becomes: “How do we scale this up so that the innovation spreads, more people benefit, and it becomes business as usual?”
As part of the Implementation Team within NHS RightCare, I work with local health economies in the north region, where innovative implementation has been achieved, to understand why and to gather the learning gained. This adoption can then be evaluated, tested and, ultimately, driven out nationally to spread good practice.
While there is no generic recipe for the sustainable implementation of innovative practice, there are certain practices which will increase the likelihood of success:
- Ensuring the benefit to patients and the system is clearly articulated.
- Ensuring the case for change makes sense to key decision makers.
- Having a robust evidence base – balanced between clinical research and evidence which shows the benefits of implementation within a live NHS system.
- Making the most of all sources of local intelligence to help build the case for change.
- Where innovations can lead to wider pathway improvements, approaching these at a system level, with all stakeholders working collaboratively.
- Ensuring clinical leadership and wider stakeholder engagement at the beginning of the process.
- Involving patients in the implementation process wherever possible.
- Using tried and tested improvement methodologies and rigorous project management.
I believe that the NHS is now making great strides in speeding up the adoption of new and innovative practices and that the increased use of continuous improvement methodologies is driving this positive direction of travel.
The innovation pathway for new technologies, via the Academic Health Science Networks, has become clearer and the support and incentives for the NHS to be more innovative has been strengthened.
It is now important to capitalise on this momentum and for all parts of the NHS to work in partnership to harness the potential of new technologies for improved patient outcomes.